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Macular Hole

A macular hole is a hole in the macula, the sensitive part of the retina that is located at the back of the eye. The macula contains light-sensitive cells which provide clear, sharp central vision. Specifically, the hole or defect occurs in the fovea, the center of the macula and the most delicate part of the entire retina.

Causes of a Macular Hole

Macular holes almost always develop as a result of the natural aging process, when the vitreous, the gel that fills most of the eye, thins and separates from the macula. This can produce a pull on the macula causing a hole to develop. Less commonly, macular holes can be caused by:

  • Eye injury
  • Intraocular inflammation
  • Retinal detachment
  • Nearsightedness
  • Macular pucker

Most cases of a macular hole occur in people over the age of 60.

Stages of a Macular Hole

There are three stages in the development of a macular hole, they are as follows:

  • Stage 1 – foveal detachment
  • Stage 2 – partial thickness macular hole
  • Stage 3 – full thickness macular hole

Each stage can progress to the next if not treated. When a stage 3 macular hole develops, most of the central and detailed vision is lost.

Symptoms of a Macular Hole

At first a macular hole may only cause a small blurry or distorted area in the center of vision. As the hole grows over several weeks or months, central vision progressively worsens. Peripheral vision is not affected and there is no risk of blindness.

Treatment of a Macular Hole

While some macular holes resolve on their own, in most cases surgery is required to effectively restore vision. The success rate of the surgery varies based on the severity of the condition. An outpatient procedure, known as a vitrectomy, is performed to replace the vitreous gel, and a gas bubble is injected into the eye to help close the hole. As the eye heals, the fluid is naturally replaced. There is no other non-surgical alternative to treat macular holes.

Left untreated, a macular hole can develop into a detached retina.


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